URGE Quiz and BOFs

Question 1

Answer 1

3. Endorphin and ACTH are both produced from the same precursor protein POMC

The correct answer is:

1. Which endocrine hormone is released by somatotrophs? → Growth hormone,
2. Which hormone acts to increase the reabsorption of water from the collecting ducts and distal convoluted tubules of the kidney? → Antidiuretic hormone,
3. Which hormone is co-released with adrenocorticotropic hormone? → Endorphin

Question 2

Answer 2

Cortisol is a steroid hormone, which bind to an intracellular receptor. All other hormones are peptide hormones that bind to membrane receptors.

The correct answer is: Cortisol

Question 3

Answer 3

A cytokine is a regulatory peptide, usually acting close to the site where it is secreted, to control cell development, differentiation and the immune response. In stress and inflammation, cytokines are transported in the circulation to act on distant targets. They differ from hormones in that they are made on demand and are not secreted from specialised glands. A paracrine is a chemical secreted by a cell to act on cells in its immediate vicinity. A chemical that acts on the cell that releases it is an autocrine. A neurotransmitter is a chemical released from a neurone and diffuses across a narrow extracellular space to act on its target cell.

The correct answer is: Hormone

Question 4

Answer 4

The correct answer is: Pituitary : hypothalamus

Question 5

Answer 5

The correct answer is: Negative feedback mechanisms

Question 6

Answer 6

Prolactin is released from the anterior pituitary by PRH (prolactin releasing hormone) (vasoactive intestinal peptide) produced in the hypothalamus and released into the hypothalamic-pituitary portal system for circulation to the anterior pituitary. Dopamine is produced in the hypothalamus and released into the hypothalamic-pituitary portal system for circulation to the anterior pituitary where it acts to inhibit the release of prolactin. Calcitonin is released from the thyroid gland (from parafollicular “C” cells) in response to increasing plasma [Ca++]. Oxytocin and antidiuretic hormone are posterior pituitary neurohormones released from nerve terminals with direct neuro-connection to the hypothalamus and requiring no releasing factor.

The correct answer is: Prolactin

Question 7

Answer 7

The release of growth hormone stimulating hormone (GHSH) is pulsatile and occurs principally during deep sleep. In turn the GHSH pulse stimulates pulsatile release of growth hormone during sleep.

The correct answer is: GH – Growth hormone / somatotropin

Question 8

Answer 8

All steroid hormones are produced from cholesterol as a precursor. The initial common pathways occur in ALL steroid hormone producing cells. Not all lipophilic hormones are produced from cholesterol (thyroid hormone is formed from the amino acids tyrosine). Dehydrocholesterol is formed in the skin and is a precursor for Vitamin D, but this is not the rate limiting step in its pathway.

The correct answer is: Steroid hormone production because cholesterol is a precursor for all steroid hormones.

Question 9

Answer 9

If there is a normal femoral pulse, this indicates there is not a significant blockage here, otherwise it would be a “water-hammer”, extra strong pulse. If there was a blockage in the deep femoral artery, then there would still be a popliteal pulse. If there was a femoral aneurysm, the femoral and/or popliteal pulses would actually be easier to feel. The most sensible location for a blockage in this case is the superficial femoral artery at the adductor hiatus. Blockages here are due to atherosclerotic processes, since this location of the artery is subjected to extra stress and forces due to passing through the connective tissue of the adductor hiatus. Embolus normally lodge at a bifurcation, so they are common in branching of the internal carotid or common femoral artery, but not likely in the location of the adductor hiatus.

The correct answer is: In the superficial femoral artery at the adductor hiatus due to atherosclerosis

Question 10

Answer 10

The neurohypophysis (posterior pituitary) is derived from an evagination of diencephalic neurectoderm. This structure is responsible for releasing oxytocin and ADH to the general circulation. Both hormones are synthesized in cell bodies contained within the hypothalamus. ACTH, prolactin, and TSH are all synthesised and released by the anterior pituitary, or adenohypophysis, which is derived from an evagination of the ectoderm of Rathke’s pouch, a diverticulum of the primitive mouth. Epinephrine is synthesised and released into the circulation by the adrenal medulla, a neural crest derivative.

The correct answer is: Oxytocin

Question 11

Answer 11

1. Low levels of GHRH and growth hormone will retard growth but it is the GHBP that is genetically predetermined and its low levels will affect the circulating levels of growth hormone.
2. In pregnancy, elevated oestrogen levels stimulate production of thyroxin binding globulin, which lowers the free circulating levels of thyroxin and triiodothyronine and reduces negative feedback inhibition of thyrotropin releasing hormone, thyroid stimulating hormone and T3 & T4. The result is increased production of triiodothyronine (T3) and thyroxine (T4) until equilibrium is restored.
3. Thyroid hormone stimulates growth hormone production in childhood. Its absence leads to inadequate growth hormone and poor bone growth and mental retardation. With thyroxine treatment, the bone growth can be largely restored but mental function cannot.

The correct answer is:
1. A low circulating plasma level of what factor is the most likely non-pathological, genetic determinant of short stature in this case? → Growth hormone binding protein,

2. During her pregnancy, Eloise’s total circulating triiodothyronine was elevated. This is a normal response that arises indirectly following the stimulatory effect of which pregnancy related factor? → Oestrogen,
3. Eloise’s child shows signs of retarded bone growth, and mental retardation in early childhood and reduced thyroid function is detected. Production of which factor that might contribute to the poor growth is likely to be reduced as a result of the reduced thyroid function? → Growth hormone

Question 12

Answer 12

The exogenous cortisol inhibits ACTH production, and the adrenal cortex becomes atrophic.

The correct answer is: Atrophy of the cortex

Question 13

Answer 13

Ataxia is an irregularity in muscular function, Alexithymia is the impaired ability to understand, process, or describing emotions, Alogia is a deficiency in the amount or content of speech, Agnosia is an inability to recognize and name objects.

The correct answer is: Anhedonia

Question 14

Answer 14

An increased plasma potassium concentration and increased ACTH also trigger the secretion of aldosterone but a decrease in intravascular blood volume is the primary stimulus.

The correct answer is: A decrease in effective intravascular blood volume

Question 15

Answer 15

This is due to negative feedback of T3 and T4 to reduce TRH release and in-turn to reduce TSH release. The feedback would also directly inhibit the release of TSH and thyroid hormones. Goitre occurs when the thyroid is overstimulated.
The correct answer is: The secretion rate of TRH declines

Question 16

Answer 16

Cortisol produces immunosuppression and will cause the organs of the immune system (e.g. thymus) to shrink. Negative feedback will cause the release of CRH to decrease but the cell bodies reside in the hypothalamus, not the anterior pituitary. ACTH release from the anterior pituitary will be reduced through negative feedback. Cortisol promotes breakdown of fat and proteins and will cause body mass to decrease.
The correct answer is: The person develops a decrease in thymus mass

Question 17

Answer 17

The elevated T4 and T3 show a hyperthyroid state. Opposite effects on TSH (lowered levels) indicate the problem is at the thyroid itself, since the elevated T4 and T3 are still feeding back to the hypothalamus and pituitary to reduce the output of TSH. When levels of T3, T4 and TSH are all affected similarly (i.e. all elevated or all lowered), then this is usually a problem at the hypothalamus or pituitary and thus a secondary form of hypo- or hyperthyroidism. If the lady’s TBG and TSH were elevated, she could be euthyroid and pregnant, but this does not result in an enlarged thyroid gland. The thyroid hormone level profile and the enlarged thyroid gland in this case could point to Grave’s autoimmune disease.
The correct answer is: Hyperthyroid, primary cause at the level of the thyroid

Question 18

Answer 18

Your answer is incorrect.

The inferior cervical ganglion contains cell bodies of postganglionic sympathetic neurons that innervate the head and neck, and also that contribute to the cardiopulmonary plexuses.

The correct answer is: Reduced sympathetic innervation to the head and neck

Question 19

Answer 19

Your answer is incorrect.

Spinal nerves leave from all spinal cord segments and all of them carry somatic motor and sensory information. Spinal nerves innervate all somatic areas from the neck down. Cranial nerves innervate somatic structures in the head (and also the neck too). All spinal nerves also carry sympathetic innervation to get to the muscles and sweat glands for a sympathetic response - this is to the limbs but also the trunk. Parasympathetic innervation is only to the trunk, these do not need to travel with spinal nerves.

The correct answer is: Somatic motor and sensory information and sympathetic innervation, to the neck down

Question 20

Answer 20

Vasopressin (otherwise known as antidiuretic hormone) is a hypothalamic neuro-hormone released from the posterior pituitary in response to osmoreceptor activation it activates ADH receptors to reabsorb and retain water in the body. Dopamine is a hypothalamic neuro-hormonel which is released into the hypothalamic-pituitary portal system and acts on receptors in the anterior piruitary unconnected with fluid retention. The other substances are produced peripherally.

The correct answer is: Antidiuretic hormone

Question 21

Answer 21

Renal sympathetic nerve stimulation releases norepinephrine which acts on the beta-adrenoreceptors on the juxtaglomerular cells of the renal afferent arterioles stimulating secretion of renin. Angiotensin II reduces renin secretion by feedback inhibition. ANP acts to inhibit reabsorption of sodium and water, thus counteracting the response to renin but has no effect on renin secretion. Increased glomerular filtration has no direct effect on renin secretion. Increasing mean blood pressure will stimulate baroreceptor reflexes and reduce sympathetic nervous activity. It will also increase pressure in the renal afferent arterioles and inhibit renin release.

The correct answer is: Increasing sympathetic nerve activity

Question 22

Answer 22

a) By inhibiting the stimulatory effect of aldosterone on Na+ reabsorption an aldosterone antagonist will indirectly increase renin secretion and hence increase Ang II.
b) Angiotensin AT1 receptor antagonists will inhibit the negative feedback of Ang II on renin secretion, which will increase and hence increase Ang II.
c) Arterioloar vasodilators will increase flow through the renal artery and stimulate renin secretion and hence increase Ang II.
d) Beta blockers are antagonists of the actions of epinephrine and norepinephrine at beta-adrenoreceptors. Beta adrenoreceptors mediate the stimulatory effects of the sympathetic nervous system on renin release from the juxtaglomerular cells of the kidney afferent arterioles. Beta-blockers will reduce the stimulus for renin release from the juxtaglomerular cells, decrease renin secretion and hence decrease Ang II.
e) Loop diuretics will reduce reabsorption of Na+ and reduce swelling of the macula densa cells, thereby increasing renin secretion and hence increase Ang II.

The correct answer is: Beta-blocker

Question 23

Answer 23

ACh acting at muscarinic receptors, noradrenaline released from sympathetic nerves causes relaxation of the detrusor muscle, ATP is co-released with acetylcholine but from parasympathetic nerves.

The correct answer is: acetylcholine released from parasympathetic nerves acting at muscarinic M3 receptors.

Question 24

Answer 24

During bladder filling, the sympathetic innervation of the bladder dome keeps the detrusor muscle relaxed, allowing the bladder to expand at low pressure.

The correct answer is: Bladder filling occurs at low intravesical pressure.

Question 25

Answer 25

1. Contraction of detrusor muscle occurs through release of acetylcholine from the parasympathetic nerve afferents contained within the pelvic nerve 2. The external urethral sphincter contraction is maintained during bladder filling by acetylcholine released from the pudendal nerve acting on nicotinic receptors The correct answer is: 1. Initiates contraction of the detrusor muscle during voiding → Pelvic nerve, 2. Maintains contraction of the external urethral sphincter during bladder filling → Pudendal nerve, 3. Integrates signals from the brain and bladder to determine when an appropriate time to void would be → Pontine micturition centre

Question 26

Answer 26

Urea is the major nitrogen waste product excreted in the urine which also contains uric acid, creatinine & ammonium ions but in smaller amounts than urea. The correct answer is: Urea

Question 27

Answer 27

The correct answer is: Cortex

Question 28

Answer 28

The left renal vein is crossed by the superior mesenteric. This vessels leaves the aorta at a sharp descending angle and can press of the left renal vein which is longer since it has to cross the aorta and the midline to the IVC. The correct answer is: In the left renal vein because it is crossed by the superior mesenteric artery which may occlude it

Question 29

Answer 29

Aldosterone is the primary regulator of water balance through its effects on the kidney to retain sodium and excrete potassium, which increases water retention (as sodium is the predominant osmotically active ion in the ECF) and increases blood volume. The correct answer is: Regulate Na+ and water balance in the ECF

Question 30

Answer 30

The hypothalamus is the endocrine centre which responds to external factors such as stress to stimulate the release of CRH, which in turn stimulates the release of ACTH by the anterior pituitary, then glucocorticoid production is triggered in the adrenal cortex. The correct answer is: Hypothalamus

Question 31

Answer 31

Plasma hydrostatic pressure of 55mm Hg is OUT of the glomerulus, whereas both the other pressures (plasma colloid pressure of 20 mm Hg and Bowman’s fluid pressure of 25 mm Hg) are of a direction of fluid movement INTO the glomerulus, since the proteins are in the fluid within the glomerulus and thus want to draw water in that way. Therefore, the balance is 55 – (20 +25) = 10mm Hg in the direction of the balance which is OUT of the glomerulus, i.e. the pressure favours fluid to pass into the capsule. The correct answer is: 10mm Hg into Bowman’s capsule

Question 32

Answer 32

The descending limb of the loop of Henle is water permeable while the ascending limb is water impermeable. The fluid in the loop of Henle goes from isotonic when it enters the medulla, to hypertonic deep in the medulla, and ends up hypotonic when it leaves the medulla due to the active pumping out of ions in the thick ascending limb, along with water impermeability here, which means water does not also leave the tubule. The correct answer is: The water impermeability of the thick ascending loop and urine that is hypotonic at the end of the Loop of Henle

Question 33

Answer 33

The perinephric fat surround the kidney and its capsule, but is contained by the renal fascia. The renal fascia of one kidney extends over across the large vessels (abdominal aorta and IVC) and surrounds the contralateral kidney and perinephric fascia. The correct answer is: It is contained in the area where the perinephric fat lies and could physically affect the large vessels and ipsilateral kidney

Question 34

Answer 34

1. Contraction of detrusor muscle occurs through release of acetylcholine from the parasympathetic nerve afferents contained within the pelvic nerve 2. The external urethral sphincter contraction is maintained during bladder filling by acetylcholine released from the pudendal nerve acting on nicotinic receptors The correct answer is: 1. Initiates contraction of the detrusor muscle during voiding → Pelvic nerve, 2. Maintains contraction of the external urethral sphincter during bladder filling → Pudendal nerve, 3. Integrates signals from the brain and bladder to determine when an appropriate time to void would be → Pontine micturition centre

Question 35

Answer 35

ACh acting at muscarinic receptors, noradrenaline released from sympathetic nerves causes relaxation of the detrusor muscle, ATP is co-released with acetylcholine but from parasympathetic nerves. The correct answer is: acetylcholine released from parasympathetic nerves acting at muscarinic M3 receptors.

Question 36

Answer 36

During bladder filling, the sympathetic innervation of the bladder dome keeps the detrusor muscle relaxed, allowing the bladder to expand at low pressure. The correct answer is: Bladder filling occurs at low intravesical pressure.

Question 37

Answer 37

Urea is the major nitrogen waste product excreted in the urine which also contains uric acid, creatinine & ammonium ions but in smaller amounts than urea. The correct answer is: Urea

Question 38

Answer 38

Ascending infection via a refluxing vesicoureteric junction is by far the most likely for a faecal organism like E. coli. Haematogenous renal infection does occur, but generally in conditions such as tuberculosis and infective endocarditis. The other routes of infection would be exceptionally rare for any organism. The correct answer is: ascending infection from the bladder

Question 39

Answer 39

A greater anion gap indicates that acid has been added to the system. An acid = H+ plus an anion (A-), e.g. lactic acid = hydrogen cation plus lactate anion. When extra acid is in plasma, bicarbonate ions will be used to buffer the extra H+, therefore the measurable plasma level of bicarbonate (HCO3) will be decreased. Because the unmeasurable anion(s) from this acid are making up the total anions, and the usually measurable HCO3 anions are lower, any increase in the anion gap is directly proportional to a decrease in the amount of measured HCO3 anions. The correct answer is: A decrease in bicarbonate levels

Question 40

Answer 40

3. As Candida is a yeast, it does not respond to antibiotic therapy. The correct answer is: 1. Mary describes symptoms of urinary frequency and burning when voiding. You suspect she has a urinary tract infection. The most likely causative organism is? → Escherichia coli, 2. You prescribe ampicillin antibiotics for Mary which she takes for 5 days. On completion of her antibiotics she develops diarrhoea. The most likely causative organism is? → Clostridium dificile, 3. Antibiotics are an ineffective treatment and Mary’s symptoms persist. You do a urine dipstick test and see high level pyuria but negative for nitrates. What organism do you now suspect? → Candida albicans

Question 41

Answer 41

Because creatinine is freely filtered by the glomerulus, but not secreted or reabsorbed to a significant extent, the renal clearance of creatinine is approximately equal to the glomerular filtration rate. In fact, creatinine clearance is commonly used to assess renal function in the clinical setting. When a kidney is removed, the total glomerular filtration rate decreases because 50% of the nephrons have been removed, which causes the creatinine clearance to decrease. In turn, the plasma creatinine concentration (choice D) increases until the rate of creatinine excretion by the kidneys (choice E) is equal to the rate of creatinine production by the body. Recall that creatinine excretion = GFR x plasma creatinine concentration. Therefore, creatinine excretion is normal when GFR is decreased following removal of a kidney because the plasma concentration of creatinine is elevated. Creatinine is a waste product of metabolism. Creatinine production (choice B) is directly related to the muscle mass of an individual, but is independent of renal function. The daily excretion of sodium (choice C) is unaffected by the removal of a kidney. The amount of sodium excreted each day by the remaining kidney exactly matches the amount of sodium entering the body in the diet. The correct answer is: Creatinine clearance

Question 42

Answer 42

The perirenal and pararenal fat support the kidney. The kidneys are surrounded by fascia that attaches the kidneys to the diaphragm and across the aorta and IVC to the contralateral kidney. While detachment of the renal fascia at the diaphragm can contribute to nephroptosis, this is not consistent with the description. The septum between the kidney and the adrenal gland is not really supportive, it is quite weak and would not cause displacement of the kidney. Nephroptosis results in kinking of the ureter. The correct answer is: Loss of pararenal and/or perirenal fat

Question 43

Answer 43

Adrenergic receptor agonists directly inhibit pancreatic insulin secretion. Antidiuretic hormone is associated with diabetes insipidus a disease characterized by excretion of large amounts of severely diluted urine and excessive thirst due to an inability of the kidney to reabsorb water rather than due to increased glucose excretion Cholecystokinin is a hormone that not only causes gallbladder contraction, but also causes insulin secretion from the pancreas. Pancreatic glucagon release acts as a paracrine stimulus for insulin secretion. Ingestion of high-sugar meals is a stimulus for the secretion of insulin from the pancreas. Muscarinic activity in the GI tract enhances secretion of insulin from the pancreas. The correct answer is: Adrenergic agonist

Question 44

Answer 44

Before you started analyzing all of the answer choices you should have reminded yourself that glucagon increases serum glucose. So an enzyme stimulated by glucagon might be involved in either the breakdown of glycogen to glucose (glycogenolysis) or in the creation of glucose from noncarbohydrate precursors (gluconeogenesis). Glycogen phosphorylase catalyzes the first step in glycogenolysis; it makes sense that it would be stimulated by glucagon. Glucokinase catalyzes the conversion of glucose to glucose-6-phosphate which helps lock glucose inside the cell. As its name implies, glycogen synthase is involved in the synthesis of glycogen. Glucagon (and epinephrine) stimulates the phosphorylation and inactivation of glycogen synthase. HMG-CoA reductase is the key enzyme involved in the synthesis of cholesterol. Since this is an anabolic process that occurs in the well-fed state, you would expect it to be stimulated by insulin and inhibited by glucagon (which it is). Pyruvate kinase catalyzes the last reaction of glycolysis. You would expect it to be inhibited by glucagon (thus decreasing the amount of glucose consumption). Glucagon promotes the phosphorylation of pyruvate kinase, which renders it inactive. The correct answer is: Glycogen phosphorylase

Question 45

Select one: a. Glucagon b. Insulin c. Pancreatic polypeptide d. Proinsulin e. Somatostatin

Answer 45

The region circled is the centre of a pancreatic islet. The pancreatic B-cells are localized to the centre of the islet. These cells secrete Insulin, C peptide, amylin and a small amount of proinsulin. Glucagon is secreted by the A cells which are located more peripherally. Scattered throughout the islet are the D cells and the F cells which secrete somatostatin and pancreatic polypeptide respectively. The correct answer is: Insulin

Question 46

Answer 46

Lack of insulin would result in a metabolic setting that resembles ‘starvation’, which means that processes that are normally activated by insulin are NOT active (i.e., glycogen synthesis). In contrast, those processes, which are normally blocked by insulin, are now active (i.e., lipolysis stimulated by hormone-sensitive lipase in adipose tissue [NOT in the liver]). Ketone body formation (e.g. β-hydroxybutyrate) is activated The correct answer is: Increased gluconeogenesis from lactate

Question 47

Answer 47

Lipoprotein lipase is important for the extraction of triacyl glycerols from both chylomicrons and VLDLs; therefore answer B is correct. The correct answer is: Elevation of both plasma chylomicrons and very low-density lipoproteins.

Question 48

Answer 48

Chylomicrons are normally synthesised in the intestinal epithelial cells after a meal. They serve to transport the dietary fatty acid into the lymphatic system and eventually into the blood. Synthesis of apolipoproteins is necessary for their assembly. Defects result in the accumulation of fats in these epithelial cells. The correct answer is: Decreased synthesis of an apolipoprotein.

Question 49

Answer 49

The 16-year-old probably has type 1 (juvenile onset) diabetes mellitus, while the 65-year-old probably has type 2 (maturity onset) diabetes mellitus. These two types of diabetes differ in many respects. Ketoacidosis is more apt to develop in type 1 diabetes. Type 2 diabetics tend to be obese (choice B), while type 1 diabetics are often thin. Type 1 is usually apparently due to viral or immune destruction of beta cells, while type 2 is apparently usually due to increased resistance to insulin; consequently the 65-year-old, rather than the 16-year-old, is more likely to have relatively high endogenous levels of insulin (choice D). Type 2 diabetes can often be controlled with oral hypoglycemic agents (choice A), while type 1 diabetics generally require insulin. Note that some type 2 diabetics also may require insulin as the disease evolves. Autoimmune destruction of beta-cells (by islet cell antibodies) has been implicated in the causation of type 1 diabetes, but not in type 2 diabetes (choice E). The correct answer is: Develop ketoacidosis have relatively high endogenous insulin levels

Question 50

Answer 50

The sympathetic innervation of the kidneys and ureters comes mostly from spinal cord levels T12, L1, L2. Spinal nerves that enter/exit these same levels have dermatomes over the lumbar and groin regions, and thus they bring sensory information from these areas. The brain receives the message of pain from the visceral afferents from the kidney, but processes it as somatic pain, at these dermatomes. The correct answer is: Spinal nerves carrying sensory information from these areas enter the spinal cord at the same level as the renal nerves.

Question 51

Answer 51

The correct answer is: Urine pH = 7.2, leucocytes ++, nitrite positive, blood trace

Question 52

Answer 52

The correct answer is: Urine pH = 4.8, glucose +++, ketones +++, nitrite negative, leucocytes negative

Question 53

Answer 53

The MAP-kinase signalling pathway is usually activated by growth factor receptors (i.e. receptor tyrosine kinases) via activation of the Ras protein, NOT by adrenaline (A), steroid hormones (D) or the second messengers Ca++ (E) or cAMP (C). The correct answer is: Is activated through a receptor tyrosine kinase

Question 54

Answer 54

a) VEGF stimulates blood vessel formation and increased blood supply in solid tumour and therefore stimulates tumour growth in this scenario. In fact, INHIBITING the VEGF receptor activity is one of the successful approaches to reduce tumour growth. b) Proto-oncogenes are the NORMAL counterparts of oncogenes, so inhibiting these is less likely to be successful. c) Again, one of the approaches in modern cancer research is to try and ‘convince’ cancer cells to undergo apoptosis. d) Knocking out the p53 (tumour suppressor) gene would promote cancer. e) Correct answer. The correct answer is: The development of inhibitors that target specific tyrosine kinases involved in growth factor signalling

Question 55

Answer 55

Virus-induced cancers in total comprise only 15-20% of human cancers. Epstein-Barr virus is a typical example, where about 90% of the population is infected, and in most cases the infection is latent. The latency periods may be rather long. Quite a few animal models substantially helped to advance our knowledge on human cancer biology. Host factors can significantly contribute to the development of virus-induced cancer (e.g. immune-compromised patients) The correct answer is: Not all infections with a human tumour virus lead to tumour formation

Question 56

Answer 56

RNA-dependent DNA polymerase activity is the correct answer. RNA to DNA is the reversal of the normal flow of genetic information, which is from DNA to RNA. That’s were the enzyme got its name from. The correct answer is: RNA-dependent DNA polymerase activity

Question 57

Answer 57

The correct answer is: When empty, it is located within the true pelvis

Question 58

Answer 58

The segmental arteries supply an individual segment so are clinically useful for resection. The anterior branch of the renal artery supplies 4 renal segments (superior, anterior superior, anterior inferior and inferior), and the posterior branch of the renal artery supplies only the posterior segment. The correct answer is: Superior segmental artery

Question 59

Answer 59

This can then continue beyond the external oblique ring, but internal ring of the inguinal canal is lateral to the inferior epigastric vessels. Option E describes a direct inguinal hernia. The correct answer is: Passes into the inguinal canal, just lateral to the inferior epigastric vessels, and can continue into the groin

Question 60

Answer 60

a) is incorrect because it would make no sense to have a growth factor binding region on the inside of a cell c) is incorrect because it would make no sense to have a growth factor binding region on the inside of a cell d) is incorrect because with two ectodomains there is no connection with the intracellular (cytoplasmic) region of the cell e) is incorrect because it would make no sense to have two intracellular domains, ie. with no way of detecting an incoming extracellular growth factor molecule The correct answer is: An ectodomain which has a growth factor binding region and an intracellular domain with a tyrosine kinase region

Question 61

Answer 61

The letter p indicates that the TNM classification is the result of pathological examination. The correct answer is: p

Question 62

Answer 62

The correct answer is: Bacterial vaginosis

Question 63

Answer 63

Anogenital Cancers is the correct answer; cervical cancer, the most common one falls into this group. The correct answer is: Anogenital Cancers

Question 64

Answer 64

In females: LH stimulates steroidogenesis in the ovarian follicle and corpus luteum, follicular development beyond the antral stage, ovulation and luteinization. In males: LH acts on the Leydig cells to promote testosterone synthesis. Testosterone then acts via an intratesticular paracrine mechanism to reinforce the spermatogenic effects of FSH in the Sertoli cells. The correct answer is: LH

Question 65

Answer 65

In the luteal (or secretory) phase of the menstrual cycle, progesterone causes the endometrial cells to enlarge and secrete a small amount if fluid which is rich in glycogen. The endometrium therefore continues to thicken until near the end of the phase when progesterone levels decrease. This allows the spiral arteries of the endometrium to constrict, causing ischemia and the endometrium becomes necrotic and sheds unless pregnancy occurs. The correct answer is: Progesterone

Question 66

Answer 66

The increase in body temperature occurs a as a result of elevated progesterone levels during the luteal (secretory) phase of the menstrual cycle. Progesterone increases the set-point temperature in the hypothalamic thermoregulatory centre. The correct answer is: Progesterone on the hypothalamus.

Question 67

Answer 67

The correct answer is: Anteflexion

Question 68

Answer 68

The correct answer is: Candida albicans

Question 69

Answer 69

The correct answer is: Treponema pallidum

Question 70

Answer 70

Anti-Mullerian hormone is present in males, and if absent it allows the female reproductive tract to persist in males, and can also lead to potentially intra-abdominal testes. In a male, development of the Wolffian tract is influenced by testosterone and development of the external genitalia by DHT. In females, anti-Mullerian hormone is absent anyway, so they are not affected by a reduction in this. This absence allows the development of the female reproductive tract, while the absence of testosterone causes the Wolffian tract to degenerate. The correct answer is: Persistence of the uterus and uterine tubes in a male

Question 71

Answer 71

Sex-cord stromal tumours (e.g. Leydig cell tumours of the testis) often produce androgens. This would account for precious puberty in this patient. Although the other tumours listed can also secrete a variety of substances, it would be very rare for any of them to produce precocious puberty. The correct answer is: Sex-cord-stromal tumour

Question 72

Answer 72

The correct answer is: Urine and semen

Question 73

Answer 73

The correct answer is: 1. Which of the above muscles is involved in anchoring the crura of the corpus cavernosum to the ischiopubic ramus? → Ischiocavernosus, 2. Which of the above muscles contracts to force blood into the glans of the clitoris? → Bulbospongiosus, 3. The pelvic floor (diaphragm) is formed by the levator ani and which of the above listed muscles? → Coccygeus

Question 74

Answer 74

The majority of causes of chronic pelvic pain to not appear to have a pathological cause, but of those that do, endometriosis the predominant one The correct answer is: Endometriosis

Question 75

Answer 75

Assessment of acute pelvic pain should involve taking a patient history, examination then investigations such as pregnancy test and urinalysis The correct answer is: Patient history

Question 76

Answer 76

The majority of circulating testosterone is bound to plasma protein (around 98%), rather than existing in free form (choice C). Of this, a majority is bound to a specific sex steroid-binding protein (choice E), and a minority is bound to albumin (choice D). Dihydrotestosterone is produced from testosterone in the tissues by a specific enzyme, 5-alpha-reductase, rather than circulating in bound (choice A) or free (choice B) form The correct answer is: Testosterone bound to sex-steroid-binding globulin

Question 77

Answer 77

PCR is cost-effective but this is not the major reason it is so widely used (a); PCR is fast, but a complete experiment consists of many cycles which each take a few minutes so the PCR itself takes a few hours (b); PCR does require only a relatively low level of technical skill but, again, this is not the main reason it has been so successful (c); It does require knowledge of the tragte DNA sequence for the preparation of primers, which are esstential for Step 2 of the PCR reaction and amplification of DNA (e) The correct answer is: It produces large amounts of DNA from minute amounts of sample

Question 78

Answer 78

Galactosemia is an autosomal recessive disease caused by a deficiency of galactose-1-phosphate uridyltransferase, which is necessary for the metabolism of the galactose derived from milk lactose. The condition should be suspected in infants with growth failure, cataracts, liver disease, aminoaciduria, and mental retardation. A reducing sugar (galactose) is usually present in the urine. Most of the pathology is related to the toxic effects of galactose-1-phosphate. Treatment involves strict dietary lactose restriction, which consists of more than simply withdrawal of milk products, because lactose is also present in many non-diary foods. Strict adherence to the diet can strikingly alter the course of this disease. Cystic fibrosis is associated with maldigestion, pancreatic disease, and pulmonary disease. McArdle's disease is a glycogen storage disease that selectively affects muscle. Von Gierke's disease is a glycogen storage disease affecting the liver and kidneys. Wilson's disease is a caused by a metabolic abnormality in the handling of copper that can cause cirrhosis and brain damage, and usually presents in adolescence. The correct answer is: Galactosemia

Question 79

Answer 79

The correct answer is: Prostate

Question 80

Answer 80

The correct answer is: Genital branch of the genitofemoral nerve

Question 81

Answer 81

a) Shortly before birth, some of the oogonia transform into primary oocytes b) If fertilization occurs, the secondary oocyte undergoes meiosis II and a second polar body is formed. c) at menarche, ovulation occurs but if there is no fertilization the oocyte dies & does not complete meiosis d) Oogonia undergo mitotic proliferation until month 5 of gestation when they become dormant e) At puberty, FSH stimulates the primary oocyte to undergo meiosis I forming a secondary oocyte and 1st polar body The correct answer is: Fertilization

Question 82

Answer 82

Yes, studies using GH supplementation in the elderly have revealed detrimental side effects, including an increased likelihood of diabetes. GH has metabolic actions resulting in increased blood fatty acids and glucose levels. After closure of the epiphyseal plates in his long bones, a 29 year old man will not experience further height increase. GH mobilizes fat stores for use as an energy source, promoting leanness Excess endogenous GH, via IGF, would result in increased protein synthesis in most organs, and increased (not decreased) organ size. Testosterone, not GH, stimulates the male sex drive. The correct answer is: Increased likelihood of diabetes

Question 83

Answer 83

Turner’s syndrome (45, X) is the only chromosomal abnormality of those given which is an example of monosomy and is a deficiency of a sex chromosome (most often the male X chromosome). Kleinfelter’s syndrome (47, XXY) is an abnormality in which an individual gains an extra sex chromosome, Patau, Edward’s and Down’s syndromes are all trisomies of chromosomes 13, 18 and 21, respectively. The correct answer is: Turner’s syndrome

Question 84

Answer 84

Robertsonian (unbalanced translocations) account for the majority of Down’s syndrome cases resulting from mechanisms apart from non-disjunction (~ 5%). The danger of this lies in the fact that couples who have a child with the translocation form of Down’s syndrome have a relatively high risk of having further affected children if one of them carries the chromosomal rearrangement in a balanced form. The correct answer is: Translocation

Question 85

Answer 85

Congenital heart disease or congenital heart defects, as they are also called, have an incidence of 0.5 – 1%. They include conditions such as VSDs (ventricular septal defects), ASDs (atrial septal defects) which are considered minor and more major abnormalities such as ductal dependent anomalies and hypoplastic left heart (where the left side of the heart is very poorly formed and cannot support the main circulation). The correct answer is: Congenital heart disease

Question 86

Answer 86

The basilic and cephalic veins both originate at the dorsal venous network, the basilica on the medial side. The basilic runs medially along the forearm and arm, and in the upper 1/3 of the arm it runs deeper, and when it merges with brachial vein, it forms the axillary vein. The cephalic vein runs anteriolaterally on the forearm and arm, and terminates in the most medial part of the axillary vein, more proximal than basilic. The correct answer is: The basilic vein originates at the dorsal venous network and passes along the medial side of the forearm and arm

Question 87

Answer 87

65-75% of congenital abnormalities are of unknown or multifactorial origin. The correct answer is: Unknown or multifactorial

Question 88

Answer 88

Congenital heart disease or congenital heart defects, as they are also called, have an incidence of 0.5 – 1%. They include conditions such as VSDs (ventricular septal defects), ASDs (atrial septal defects) which are considered minor and more major abnormalities such as ductal dependent anomalies and hypoplastic left heart (where the left side of the heart is very poorly formed and cannot support the main circulation). The correct answer is: Congenital heart disease

Question 89

Answer 89

Cytomegalovirus (CMV) is a DNA herpesvirus and is the most common cause of foetal infection, affecting 0.5 – 2% of neonates. There is no vaccine and the severity and exact nature of its affects on the foetus are impossible to predict. The correct answer is: Cytomegalovirus (CMV)

Question 90

Answer 90

The umbilicus is at the level of the T10 dermatome, which indicates this corresponds with sympathetic supply and pain afferent from the midgut. Non-specific pain here is due to referred pain. Visceral pain come start off as truly visceral pain when it is not very strong, but then is only ever felt as referred pain, according to dermatomes and corresponding spinal cord levels. The parietal peritoneum is innervated by somatic innervation, the same as the overlying abdominal wall. The correct answer is: Referred pain from ischaemia in his ileum

Question 91

Answer 91

If this man has no signs of visceral dysfunction, then it is unlikely that his internal iliac arteries are blocked bilaterally (even if this was a distal blockage, it would still affect middle rectal branch!). External iliac, and external pudendal (which branches from common femoral, the extension of external iliac), do not supply the penis, just the superficial skin. Perineal artery supplies the perineal membrane, and the proximal part of the corpus spongiosum, but it the the corpus cavernosum (supplied by the deep arteries of the penis, from internal pudendal) that are the major erectile tissue. The correct answer is: Internal pudendal artery

Question 92

Answer 92

The correct answer is: a) A low circulating plasma level of what factor is the most likely non-pathological, genetic determinant of short stature in this case? → Growth hormone binding protein, b) During the pregnancy, the mother's total circulating triiodothyronine was elevated. This is a normal response that arises indirectly following the stimulatory effect of which factor? → Oestrogen, c) The child shows signs of retarded bone growth, and mental retardation in early childhood and reduced thyroid function is detected. Production of which factor that might contribute to the poor growth is likely to be reduced as a result of the reduced thyroid function? → Growth hormone

Question 93

Answer 93

The correct answer is: a) Which hormone promotes gluconeogenesis and lipolysis? → Growth hormone, b) Which hormone is produced by Sertoli cells? → Inhibin, c) Which hormone is co-released with adrenocorticotropic hormone? → Endorphin

Question 94

Answer 94

The correct answer is: a) This agent is responsible for the greatest number of foetal infections in utero. No immunisation is currently available and often the mother is asymptomatic. → Cytomegalovirus, b) Before the introduction of routine childhood vaccinations in Australia this agent commonly caused epididymoorchitis with a risk of subsequent male infertility. → Mumps virus (Paramyxovirus), c) This agent is responsible for balanitis in males (inflammation of the glans penis) and a ‘curdy’ discharge in females. → Candida albicans

Question 95

Answer 95

The correct answer is: a) A 23-year-old woman is prescribed a combined oral contraceptive pill. The oestrogen component of this contraceptive works via which of the above mechanisms? → Negative feedback , b) A 76-year-old woman with hypertension and peripheral oedema is prescribed a diuretic agent. This agent works by enhancing which of the above mechanisms? → Active transport, c) A 32-year-old man presents to his doctor with painful urination. He is found to be infected with chlamydia and is prescribed a tetracycline antibiotic. The antibiotic works by inhibiting which of the above mechanisms? → Protein synthesis

Question 96

Answer 96

The correct answer is: Decreased plasma volume

Question 97

Answer 97

The correct answer is: Fasting plasma glucose

Question 98

Answer 98

The correct answer is: Inhibition of endogenous cholesterol synthesis

Question 99

Answer 99

The correct answer is: Leucocytes++, nitrite positive, blood trace

Question 100

Answer 100

The correct answer is: Bone

Question 101

Answer 101

The correct answer is: Serology

Question 102

Answer 102

The correct answer is: predisposition to urinary tract infection.

Question 103

Answer 103

The correct answer is: A secure attachment

Question 104

Answer 104

The correct answer is: spiral arteries.

Question 105

Answer 105

The correct answer is: Nephroptosis due to loss of pararenal fat

Question 106

Answer 106

The correct answer is: Adrenal cortex

Question 107

Answer 107

The correct answer is: Normal free thyroid hormone and increased total thyroid hormone

Question 108

Answer 108

The correct answer is: Nicotinic receptors

Question 109

Answer 109

The correct answer is: Primary prevention

Question 110

Answer 110

The correct answer is: be able to detect disease at an early stage.

Question 111

Answer 111

The correct answer is: the cost of care of those affected.

Question 112

Answer 112

The correct answer is: Ovary

Question 113

Answer 113

The correct answer is: consanguinity.

Question 114

The image shows a light micrograph of the renal corpuscle. What is the structure indicated by the arrow? Select one: Bowman’s capsule Capsular space Glomerular capillary Macula densa Proximal convoluted tubule

Answer 114

The correct answer is: Bowman’s capsule

Question 115

A man presents with symptoms of urinary incontinence that he has noticed progressively increasing over the last few weeks. He explains that he doesn’t have a problem starting to urinate, but that whilst urinating, he is unable to stop the flow. Which of the pinned muscles shown above most likely has reduced tone? **Select one:** Muscle A Muscle B Muscle C Muscle D Muscle E

Answer 115

The correct answer is: Muscle C

Question 116

**Select one:** Cortisol Growth hormone Insulin Prolactin Thyroxine

Answer 116

The correct answer is: Cortisol

Question 117

A woman who gave birth 8 weeks ago is experiencing dysparenuria. A small, precancerous lesion in the region identified (by the yellow arrow) needs to be destroyed via cauterisation. Where would it be most appropriate to deliver anaesthetic prior to a minor cauterisation procedure? **Select one:** Into the epidural space in the lumbar spinal region Into the epidural space in the sacral canal Into the perineal nerves as they cross the perineal membrane Into the pudendal nerves as they pass medially to the ischial tuberosities Into the subarachnoid space at levels L3-L4

Answer 117

The correct answer is: Into the epidural space in the sacral canal

Question 118

A newborn female was suspected to have a chromosome abnormality, based on her phenotypic appearance. A karyotype analysis was performed, and the karyotype above was observed. What is the most likely diagnosis? **Select one:** Down syndrome Fragile X syndrome Klinefelter syndrome Prader-Willi syndrome Turner syndrome

Answer 118

The correct answer is: Turner syndrome

Question 119

During surgery to remove a rectal carcinoma, a surgeon would ligate the blood supply to the rectum at which location indicated on the image? ## Footnote Select one: Location A Location B Location C Location D Location E

Answer 119

The correct answer is: Location E

Question 120

A 14-year-old boy is found to have an abscess in the ischioanal fossa. There is quite a large collection of pus; this could be found: ... **Select one:** deep to the area shaded “A” deep to the structures labelled “B” superficial to the area shaded “A”. superficial to both shaded structures superior to the structures labelled “B”.

Answer 120

The correct answer is: deep to the area shaded “A”.

Question 121

Peritubular capillaries communicate with which section of the nephron? **Select one:** Section A Section B Section C Section D Section E

Answer 121

The correct answer is: Section D